Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis.

Background: The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students. Method: A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed. Results: The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective. Conclusions: Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning

The lung inflammation and skeletal muscle wasting induced by subchronic cigarette smoke exposure are not altered by a high-fat diet in mice

Obesity and cigarette smoking independently constitute major preventable causes of morbidity and mortality and obesity is known to worsen lung inflammation in asthma. Paradoxically, higher body mass index (BMI) is associated with reduced mortality in smoking induced COPD whereas low BMI increases mortality risk. To date, no study has investigated the effect of a dietary-induced obesity and cigarette smoke exposure on the lung inflammation and loss of skeletal muscle mass in mice. Male BALB/c mice were exposed to 4 cigarettes/day, 6 days/week for 7 weeks, or sham handled. Mice consumed either standard laboratory chow (3.5 kcal/g, 12% fat) or a high fat diet (HFD, 4.3 kcal/g, 32% fat). Mice exposed to cigarette smoke for 7 weeks had significantly more inflammatory cells in the BALF (P<0.05) and the mRNA expression of proinflammatory cytokines and chemokines was significantly increased (P<0.05); HFD had no effect on these parameters. Sham- and smoke-exposed mice consuming the HFD were significantly heavier than chow fed animals (12 and 13%, respectively; P<0.05). Conversely, chow and HFD fed mice exposed to cigarette smoke weighed 16 and 15% less, respectively, compared to sham animals (P<0.05). The skeletal muscles (soleus, tibialis anterior and gastrocnemius) of cigarette smoke-exposed mice weighed significantly less than sham-exposed mice (P<0.05) and the HFD had no protective effect. For the first time we report that cigarette smoke exposure significantly decreased insulin-like growth factor-1 (IGF-1) mRNA expression in the gastrocnemius and tibialis anterior and IGF-1 protein in the gastrocnemius (P<0.05). We have also shown that cigarette smoke exposure reduced circulating IGF-1 levels. IL-6 mRNA expression was significantly elevated in all three skeletal muscles of chow fed smoke-exposed mice (P<0.05). In conclusion, these findings suggest that a downregulation in local IGF-1 may be responsible for the loss of skeletal muscle mass following cigarette smoke exposure in mice. © 2013 Hansen et al

The Sunyaev-Zeldovich Effect and Its Cosmological Significance

Comptonization of the cosmic microwave background (CMB) radiation by hot gas in clusters of galaxies - the Sunyaev-Zeldovich (S-Z) effect - is of great astrophysical and cosmological significance. In recent years observations of the effect have improved tremendously; high signal-to-noise images of the effect (at low microwave frequencies) can now be obtained by ground-based interferometric arrays. In the near future, high frequency measurements of the effect will be made with bolomateric arrays during long duration balloon flights. Towards the end of the decade the PLANCK satellite will extensive S-Z surveys over a wide frequency range. Along with the improved observational capabilities, the theoretical description of the effect and its more precise use as a probe have been considerably advanced. I review the current status of theoretical and observational work on the effect, and the main results from its use as a cosmological probe.Comment: Invited review; in proceedings of the Erice NATO/ASI `Astrophysical Sources of High Energy Particles and Radiation'; 11 pages, 3 figure

Determinants for Successful Agile Collaboration between UX Designers and Software Developers in a Complex Organisation

Agile and User-centered design processes have been reported to frequently putting contradictory demands on people working within these methodological frameworks. The current research addresses this point by focussing on the crucial relationship between software developer and designer. An online survey, a contextual inquiry, and a diary study were employed with 107 developers and designers in a large media organization to determine the factors for success in agile development cycles. The results from the survey show that while developers and designers have similar levels of satisfaction with agile processes, there are differences in the factors predicting those ratings. Developers are happier with the wider teamwork but want more access to and close collaboration with designers, while the latters’ concern was the quality of the wider teamwork. Additional contextual inquiries and a diary study with pairs of designers and developers reflected the survey findings that close cooperation (and proximity) was essential for improving communication, reducing inefficiencies, and avoiding suboptimal products being released. However, organizational processes, the setup of the work environment, and managerial traditions meant that this close collaboration and localized decision-making was found difficult to maintain. Results from the survey, the contextual inquiry, and the diary study found six factors for success from collaborations emerged

Combinatorial RNA Design: Designability and Structure-Approximating Algorithm

In this work, we consider the Combinatorial RNA Design problem, a minimal instance of the RNA design problem which aims at finding a sequence that admits a given target as its unique base pair maximizing structure. We provide complete characterizations for the structures that can be designed using restricted alphabets. Under a classic four-letter alphabet, we provide a complete characterization of designable structures without unpaired bases. When unpaired bases are allowed, we provide partial characterizations for classes of designable/undesignable structures, and show that the class of designable structures is closed under the stutter operation. Membership of a given structure to any of the classes can be tested in linear time and, for positive instances, a solution can be found in linear time. Finally, we consider a structure-approximating version of the problem that allows to extend bands (helices) and, assuming that the input structure avoids two motifs, we provide a linear-time algorithm that produces a designable structure with at most twice more base pairs than the input structure.Comment: CPM - 26th Annual Symposium on Combinatorial Pattern Matching, Jun 2015, Ischia Island, Italy. LNCS, 201

Computational and Mathematical Modelling of the EGF Receptor System

This chapter gives an overview of computational and mathematical modelling of the EGF receptor system. It begins with a survey of motivations for producing such models, then describes the main approaches that are taken to carrying out such modelling, viz. differential equations and individual-based modelling. Finally, a number of projects that applying modelling and simulation techniques to various aspects of the EGF receptor system are described

How and why DNA barcodes underestimate the diversity of microbial eukaryotes

Background: Because many picoplanktonic eukaryotic species cannot currently be maintained in culture, direct sequencing of PCR-amplified 18S ribosomal gene DNA fragments from filtered sea-water has been successfully used to investigate the astounding diversity of these organisms. The recognition of many novel planktonic organisms is thus based solely on their 18S rDNA sequence. However, a species delimited by its 18S rDNA sequence might contain many cryptic species, which are highly differentiated in their protein coding sequences. Principal Findings: Here, we investigate the issue of species identification from one gene to the whole genome sequence. Using 52 whole genome DNA sequences, we estimated the global genetic divergence in protein coding genes between organisms from different lineages and compared this to their ribosomal gene sequence divergences. We show that this relationship between proteome divergence and 18S divergence is lineage dependant. Unicellular lineages have especially low 18S divergences relative to their protein sequence divergences, suggesting that 18S ribosomal genes are too conservative to assess planktonic eukaryotic diversity. We provide an explanation for this lineage dependency, which suggests that most species with large effective population sizes will show far less divergence in 18S than protein coding sequences. Conclusions: There is therefore a trade-off between using genes that are easy to amplify in all species, but which by their nature are highly conserved and underestimate the true number of species, and using genes that give a better description of the number of species, but which are more difficult to amplify. We have shown that this trade-off differs between unicellular and multicellular organisms as a likely consequence of differences in effective population sizes. We anticipate that biodiversity of microbial eukaryotic species is underestimated and that numerous ''cryptic species'' will become discernable with the future acquisition of genomic and metagenomic sequences

In situ epitaxial MgB2 thin films for superconducting electronics

A thin film technology compatible with multilayer device fabrication is critical for exploring the potential of the 39-K superconductor magnesium diboride for superconducting electronics. Using a Hybrid Physical-Chemical Vapor Deposition (HPCVD) process, it is shown that the high Mg vapor pressure necessary to keep the MgB$_2$ phase thermodynamically stable can be achieved for the {\it in situ} growth of MgB$_2$ thin films. The films grow epitaxially on (0001) sapphire and (0001) 4H-SiC substrates and show a bulk-like $T_c$ of 39 K, a $J_c$(4.2K) of $1.2 \times 10^7$ A/cm$^2$ in zero field, and a $H_{c2}(0)$ of 29.2 T in parallel magnetic field. The surface is smooth with a root-mean-square roughness of 2.5 nm for MgB$_2$ films on SiC. This deposition method opens tremendous opportunities for superconducting electronics using MgB$_2$